Page 19 Acute Pain Management
P. 19
SUMMARY OF KEY MESSAGES
A description of the levels of evidence and associated symbols can be found in the
Introduction (see pages vii to viii).
1. PHYSIOLOGY AND PSYCHOLOGY OF ACUTE PAIN
Psychological aspects of acute pain
1. Preoperative anxiety, catastrophising, neuroticism and depression are associated with
higher postoperative pain intensity (U) (Level IV).
2. Preoperative anxiety and depression are associated with an increased number of PCA SUMMARY
demands and dissatisfaction with PCA (U) (Level IV).
Pain is an individual, multifactorial experience influenced by culture, previous pain
events, beliefs, mood and ability to cope (U).
Progression of acute to chronic pain
1. Some specific early anaesthetic and/or analgesic interventions reduce the incidence of
chronic pain after surgery (S) (Level II).
2. Chronic postsurgical pain is common and may lead to significant disability (U) (Level IV).
3. Risk factors that predispose to the development of chronic postsurgical pain include the
severity of pre‐ and postoperative pain, intraoperative nerve injury and psychosocial
factors (U) (Level IV).
4. All patients with chronic postherniorrhaphy pain had features of neuropathic pain (N)
(Level IV).
5 Spinal anaesthesia in comparison to general anaesthesia reduces the risk of chronic
postsurgical pain after hysterectomy and Caesarean section (N) (Level IV).
Pre‐emptive and preventive analgesia
1. The timing of a single analgesic intervention (preincisional rather than postincisional),
defined as pre‐emptive analgesia, has a significant effect on postoperative pain relief
with epidural analgesia (R) (Level I).
2. There is evidence that some analgesic interventions have an effect on postoperative pain
and/or analgesic consumption that exceeds the expected duration of action of the drug,
defined as preventive analgesia (U) (Level I).
3. NMDA receptor antagonist drugs in particular show preventive analgesic effects (U)
(Level I).
4. Perioperative epidural analgesia combined with ketamine intravenously decreases
hyperalgesia and long‐term pain up to 1 year after colonic surgery compared with
intravenous analgesia alone (N) (Level II).
Acute pain management: scientific evidence xix
